CAse MGMT

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Author:
bcb2127
ID:
169401
Filename:
CAse MGMT
Updated:
2012-09-09 15:30:03
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Parkinsons
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Description:
Parkinsons
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  1. (obj 1)
    _____ lesion: increased DTR and positive babinski (great toe DF and fanning of toes). Modified Ashworth scale is used appropriately with a spastic, ______ lesions.
    _____ lesion: DTR may be normal. Normal babinski. Not appropriate to use modified ashworth scale since spasticity (velocity dependent) is not present.
    • Pyramidal
    • Extrapyramidal
  2. -Primary Parkinson's is ______
    -loss of _______ capacity of cells in the sustantia nigra, which send axons to the striatum.
    -Secondary Parkinson's is casued by _______ and/or ______.
    • Ideopathic
    • dopaminergic
    • infection/repeated head trauma
  3. (obj 2.4)
    _______ tremor: appears during or is accentuated by voluntary movement of the affected part and is characteristic of cerebellar disorders.Tends to increase as the limb nears its intended goal or speed is increased.
    _______ tremor: no pathological findings in this condition. Common condition that tends to run in families and progresses slowly over time. Usually equal in both hands and increases when the hands are moving. Tremor may involve the head but usually spares the legs. _____ tremor does not respond to levodopa or most other PD drugs.
    ______ tremor: tremor that is present at rest and is diminished or absent with movement or sleep. May increase with emotional stress."pill rolling" Extrapyramidal conditions of basal ganglia (i.e. basal ganglia)
    • Intention tremor
    • Essential tremor
    • Resting Tremor
  4. (obj 2.5)
    _______ tests of coordination: performed in sitting to eliminate the postural equilibrium component. Finger to nose; finger to finger; toe to therapists finger etc.
    Comparative Neuromotor signs:
    -______signs: intention tremor, ataxia, hypotonicity, dysmetrias, dysdiadochokinesis
    -______ signs: resting tremor, rigiditydskinesias/dystonias
    • -Non-equilibrium
    • -Cerebellar Signs
    • -Basal Ganglia Signs
  5. (obj 3)
    -typical age of onset of PD is ___-___ y.o. (early onset before 40)
    -Dx on basis of _____ and _____. Laboratory tests and neuroimaging procedrues are usually negative.
    -_____ is the initial symptom  in about 70% of pt.s
    -Dx can be made if 2 of the 4 cardianal signs are present: name them
    -______ (apokin) is used to rule out parkinson's plus syndromes (affect substantial nigra and elsewhere). If injection doesn't relieve akinetic signs, then it is NOT PD, but rather one of the "Parkinson-Plus"Disease.
    • -50-60 year olds
    • -history and clinical examination
    • -tremor
    • -apomorphine
  6. (obj 3)
    -Early symptoms typically present ________, and later on progress to _______. In later stages postural instability, with postural tremor, impaired responses to perturbations, loss of righting responses, and increased sway in standing.
    unilateral and later on progresses to bilateral
  7. (obj 3) Regarding prognosis, there are 2 clinical subgroups
    -______ predominant: better prognosis
    -______: relatively more deterioration with poorer prognosis and concomitant dementia more likely; occurs 13-33%
    -Regardless of onset, death is frequently caused by pneumonia or complications of dcubitus ulcers with malnutrition as an underlying factor.
    • -tremor predominant
    • -PIGD (Postural Instability Gait Disturbed)
  8. (obj 4)
    ______: slowed speed and amplitude of movement
    ______: initiation of movement is blocked, particularly for routine activities, or when a obstacle is in their path, or when dual tasking is attempted
    ______: an extapyramidal sign caused by abnormal coactivation. Lead pipe rigidiy is a constant, uniform resitance to passive movement, with no fluctuations. Cogwheel rigidity has a ratchet-like quality, likely caused by an overlayof tremor over rigidity
    _______: pill rolling, pronation/supinatino, tongue, jaw; 4-7 oscillations per second. Disappears when sleeping.
    _______: "poker face", infrequent blinking, lips parted; speech is of low volume, drooling, dysphagia
    _______: shuffling gait, with reduced stride length and increased cadence.
    • bradykinesia
    • akinesia
    • rigidity
    • resting tremor
    • masked facies
    • festinating gait
  9. (obj 5) autonomic system dysfunctions that may interfere c QOL:
    ______ ______ is impaired
    _______: increased perspiration
    _______: increased oiliness of skin
    ______ ______ and lower resting ______
    _____ incontinence/_____ dysfunction
    constipation.
    • temperature regulation
    • hyperhydrosis
    • seborrhea
    • orthostatic hypotension and lower resting bp
    • urinary incontinence
    • constipation
  10. (obj 6) The _______ Approach:
    -begins with relaxation, and deep breathing to expand rib cage
    -passive stretching and positioning, especially rotational/diagonal of pelvic/shoulder girdle and extremities
    -AROM and postural alignment
    -weight shifting
    -balance responses
    -gait activities
    -patient home exercises
    Schenkman Approach
  11. (OBj 6) tx of Parkinsons
    -allow adequate rest periods because ______ is common
    -avoid dual ____ because there is no longer "autopilot"
    -patient's should rehearse ___ ____ strategies
    -more in notes but seems common sense
    • -fatigue
    • -tasks
    • -task specific
  12. (obj 8)
    -common drugs to treat PD?
    -should be taken with large meals?high protein?
    • -l-dopa and carbidopa; carbidopa helps the % of Ldopa cross the blood brain barrier
    • -don't forget about the "honeymoon" period after onset of drugs
    • -should be taken with meals but large/high proteing meals may reduce effectiveness
  13. (obj 10)
    -______ ____:include thalamotomy (to decrease drug resistant tremor) and pallidotomy (the more common procedure to reduce rigidity, tremor,spasm,poverty of movement and off-state dystonias). Neuroblation are permanent.
    -_____ ______ stimulation: estimated that 10% of pt's with PD may benefit. Best candidates have idopathic, younger than 69, with no cognitive dysfunction. If levadopa has non effect on the person, then they would not be a candidate. (Improves mobility during off times off times, may reduce need for meds, reduces tremor, bradykinesia, and rigidity
    • -surgical procedures
    • -deep brain stimulation
  14. (obj 12)

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